partial obstruction in the airway, usually upper MEDICAL EMERGENCY IN CHILDREN

2 - Asthma Flashcards by Mark Brown

What are normal breath sounds called?

vesicular

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Describe bronchial breath sounds

tubular or hollow
characteristic pause between inspiration/ expiration - occurs in bronchial tree

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What types of crackles are there?

Coarse - through lung secretions
Fine - reopening of alveoli

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What is a Ronchial breath sounds?

a low pitched wheeze

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What is a Wheeze and what causes it?

can be monophonic or polyphonic (COPD)
caused by narrowing of the airways

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What is stridor?

partial obstruction in the airway, usually upper
MEDICAL EMERGENCY IN CHILDREN

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O SHIT ME

O xygen (94-98%)

S albutamol (5mg

H hydrocortisone (100mg IV) / prenisalone (40mg oral)

I patropium (0.5mg) (FEV < 75%)

T heophyline

M agnesium (1.2-2g IV)

E scalate

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What lines of treatment are for asthma?

1 - SABA

2 - steroid (beclemetasone)

3 - LABA

4 - increase inhaled steroids

5 - 4th drug

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What is good for aspirin induced asthma?

Montelukast - leukotriene receptor antagonist

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What does a FEV/FVC ration indicate?

>70% = restrictive

<70% = obstructive

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COPD vs Asthma

Asthma FEV can improve by 20% where as COPD is less likely

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What are the features of type1 respiratory failure?

pO2 < 8
PCO2 < 6.7 or normal
ventilation perfusion mismatch: air O2 is less than blood O2 demands

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What are the feature of type 2 respiratory failure ?

pO2 < 8
PCO2 > 6.7 - decreased
pH - inadequate ventilation and percussion building up

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What does SBAR stand for?

S ituation

B ackground

A ssessment

R ecommendation

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DR ABCDE of CXR interpretation

D etails

R IPE

A airway

B reathing

C ardiac

D iaphragm

E xtra

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D of CXR interpretation

Details

Name

DoB

AP or PA

supine or erect

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What does RIPE stand for in CXR interpretation?

Rotation - clavicle equdistance to the spine of the vertebrae Inspiration - 6-7 posterior ribs

Picture - clavicle, scapula and under the diapragm

Exposer - can the vertebrae be seen behind the mediastinum

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A of CXR interpretation

trachea deviation?
level of the carina

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B of CXR interpretation

consolidation

vesicular marking to the edge of lung

pleura - mesothelioma

C of CXR interpretation

heart borders

cardiothoracic ratio (PA)

aortic knuckle

D of CXR interpretation

air under diaphragm

costophrenic angle

cardiacphrenic angle

domes 1.5cm in height

E of CXR interpretation

bone fracture

pacemakers

soft tissue

Sarcoidosis

-bilateral hilar markings

Loss of silhouette sign

loss of costophrenic angle
indicates pneumonia etc

What is the ABCDE assesment?

**A**irway **B**reathing **C**irculation **D**isability **E**xposure and **E**verything **E**lse

How to asses Airway?

Responsive Talking Breath sounds: stridor, gurgling, snoring

What intervention may need to be done Airway?

Open airway - tilt chin lift Suction Nebulisers - salbutamol Nasopharingeal/ oropharyngeal/ igel

How would you assess breathing?

RR Sats Breath sounds Percussions

What intervestigations would you do during breathing?

Sit up O2 ABG CXR

What does Bat wings on CXR indicate

pulmonary oedema

What does bibasal crepitations indicate?

pulmonary oedema

How do you treat pulmonary oedema?

flurosemide nitrate if severe: use CPAP

On examination of the lungs there is a global wheeze. What does this indicate?

Asthma

On examination lung breath sounds are quiet and global, polyphonic wheeze. What does this indicate?

COPD

On examination lungs sound quiet at bases and dull to precuss. CXR shows loss of costophrenic and cardiophrenic angles. What des this indicate?

Plural effusion

How is a plueral effusion treated?

Treat cause if not consider chest drain

On examination precussion is hyper-resonant with decreased breath sounds with possible mediastinal shift. What does this indicate?

Tension pneumothorax (also tracheal deviation but didn't want to make it too easy)

On examinaiton lungs have localised crackles with bronchial breath sounds. What does this indicate?

Pneumonia (also raised temp, increased RR etc.)

What questions to ask an asthmatic at thier annual review?

Have you had difficulty sleeping due to asthma? Has your asthma interfeared with daily activities? Have you had your asthma symptoms during the day?

How to asses circulation?

HR BP Cap refill Temp Urine output

What interventions may need to be done in circulation?

"Two wide bore canulas" take bloods Give fluid Catherterise Do ECG "1 in, 1 out, 1 in ...."

How to assess disability?

Dont ever forget glucose - BMs AVPU or GCS PEARL

What interventions may need to be done in disablity?

IV dextrose IM glucagon

How is exposer/ everything else assessed?

Examination